Tuesday, December 3, 2013

Do I Have Carpal Tunnel Syndrome?

            At Chiropractic USA in Carmichael, CA many community members come into the office for an evaluation with a preconceived belief that they have carpal tunnel syndrome (CTS). They may have mistakenly concluded that due to the numbness and tingling in their wrist or hand, they must have this neurological disorder. Still others have ongoing forearm, wrist, or hand pain (possibly localized to the thumb and/or index finger), and are led by internet articles to personally diagnose themselves with CTS. Almost all of this is in error!

            So why are so many diagnoses of this condition mistaken? The primary culprit is non-specific clinical decision-making, compounded by a failure to understand correctly the workings of the musculoskeletal system. Carpal tunnel syndrome is a specific diagnosis which involves mechanical pressure on spinal nerves in the neck and the median nerve as it passes through a small tunnel in the wrist created by tiny adjoining bones. There's not much room in this carpal tunnel and its dimensions can be narrowed further by repetitive stress and inflammatory conditions such as osteoarthritis or rheumatoid arthritis. Pregnancy can lead to carpal tunnel syndrome owing to increased fluid retention. Repetitive postural stress may lead to inflammation of tendons that cross the wrist. Such inflammation may lead to soft tissue swelling which compresses the carpal tunnel, causing carpal tunnel syndrome.
            Importantly, carpal tunnel syndrome is not a catchall diagnosis to be used when a person has forearm, wrist, and/or hand pain. If a person really has carpal tunnel syndrome, he or she will have specific symptoms. The person will awaken at night owing to pain, numbness and/or tingling. Symptoms will be precisely located to the thumb and index finger (possibly involving the middle finger). Wrist pain may or may not be present. Also, the person will demonstrate a weakness of pinch grip involving the thumb and index finger. If these signs and symptoms are not present, the person does not have carpal tunnel syndrome. Usually, the diagnosis is clear-cut and does not require special tests such as electromyography.
            Remarkably, most physicians are unaware of these important criteria. Most the time a patients diagnosis is as follows if the patient has pain/or numbness in the hand, the patient has carpal tunnel syndrome. Case closed. This lack of sophistication leads to real harm done to the patient, such as unnecessary time wasting tests which can cost a lot of money, and may result in damaging surgery. If carpal tunnel syndrome is not present this specific surgery is not curative because its a solution for a problem that isnt actually there. A carpal tunnel syndrome diagnosis should only be determined by a highly trained professional with accurate analysis of musculoskeletal problems involving the shoulder, arm, and hand (such as a well-trained chiropractor).
            Carpal tunnel syndrome is a double crush problem, meaning that the neck and the wrist are both involved. At Chiropractic USA we use our broad knowledge and experience to correctly evaluate the situation on patients that are present with symptoms mimicking those of carpal tunnel syndrome. For example, spinal dysfunction, muscle spasm, and trigger points can all cause symptoms which appear to be those of carpal tunnel syndrome. Before a permanent surgery is performed conservative chiropractic adjustments of the wrist and neck, and postural corrective procedures should always be the first choice of treatment. If you feel you may have carpal tunnel syndrome, or if you have been recently diagnosed do your research and make an informed decision!
Tip: check out our video post on energy exercising to increase daily blood flow to your hands and wrists. ( http://www.applestozen.blogspot.com/2012/10/more-energy-in-just-5-minutes.html)

Ibrahim I, et al: Carpal tunnel syndrome. Review of the recent literature. Open Orthop J 6:69-75, 2012
Uchiyama S, et al: Current concepts of carpal tunnel syndrome: pathophysiology, treatment, and evaluation. J Orthop Sci 15(1):1-13, 2010

Bialosky JE, et al: Heightened pain sensitivity in individuals with signs and symptoms of carpal tunnel syndrome and the relationship to clinical outcomes following a manual therapy intervention. Man Ther 16(6):602-608, 2011

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